Episode 3: New Variants, New Challenges

A celebratory mood accompanied the groundbreaking discovery of the first COVID-19 vaccines in late 2020. That optimism was soon tempered by the emergence of more severe and transmissible variants, which quickly spread around the world with devastating consequences. In the third episode of the Working Dinner video series, global health leaders Dr. Folake Olayinka and Dr. Samba Sow join Anita Zaidi and Keith Klugman to discuss how these variants altered the trajectory of the pandemic and share their thoughts on how to better prepare for both future variants and the next pandemic—beginning at the community level.

This starts with communities. It doesn’t start in front of a computer sitting here in Seattle or sitting in Geneva. You have to be inside the community. You have to be where the problems are.
Dr. Samba Sow
Director General, Center for Vaccine Development (Mali)
Bill Gates, Anita Zaidi, Keith Klugman, and Lynda Stuart meet over a working dinner
The Working Dinner video series
The Gates Foundation invites you to join our co-chairs and global health experts in a series of working dinners. Watch as they share in both a meal and reflections on COVID-19 learnings that might help us prevent the next pandemic.

Meet the dinner guests

Read the transcript

Italicized remarks represent individual interviews with a guest.

ANITA ZAIDI: Hi, Samba. Hi, Folake. It’s so good to see you.

KEITH KLUGMAN: How nice to see you.

DR. SAMBA SOW: How are you? Nice to see you, too.

ANITA ZAIDI: One of the lessons in the pandemic for us at the Foundation has been understanding what’s happening on the ground and being close to our partners.

KEITH KLUGMAN: We’re really privileged today to have two guests who are really knowledgeable, not only about the virus, but also the situation on the ground in Africa. And it’s my hope that through this informal dinner, we’re going to get more insight into what has been going on in those parts of the world where we really haven’t had insight so far.

DR. FOLAKE OLAYINKA: The places that are likely to have variants or spikes in cases are also the same places where the systems to deal with them are also very weak

DR. SAMBA SOW: This starts with communities. It doesn’t start in front of a computer, sitting here in Seattle, or sitting in Geneva. You have to be inside the community.

KEITH KLUGMAN: And look what I have brought us for lunch today. It’s a South African dish that is called bobotie. The bobotie is mincemeat, and then has chutney in it, which is kind of sweet.

ANITA ZAIDI: That sounds amazing.

DR. SAMBA SOW: Looks good.

DR. FOLAKE OLAYINKA: It looks amazing.


KEITH KLUGMAN: Folake and Samba, it is our great pleasure to welcome you to Seattle. And today, we’re going to talk about the COVID pandemic, but in particular, we’re interested discussing how the variants have changed the nature of the epidemic.

When all this started, we were hoping for vaccines, and we talked a lot about flattening the curve of this pandemic to save lives. And ironically, as the first vaccines, quite miraculously, you could argue, rolled off the shelf, a variant was discovered and flattening the curve turned into trying to ride the waves, because we’ve had one wave after another.

And I guess the opening question is, what were your thoughts about the emergence of these variants and how they might impact your lives as you experienced the pandemic?

DR. FOLAKE OLAYINKA: This was really a critical moment for all of us. The moment where the variants were discovered really put a shock wave into everyone in terms of the transmissibility, and also the severity.

ANITA ZAIDI: I remember just being so depressed, sort of right after coming back into the new year in 2021, because it was just clear then that there would be these repeated waves of infections. So that concept of herd immunity and flattening the curve and all of that no longer applied.

DR. SAMBA SOW: And all of a sudden, we are going back to start a whole new big tornado again. So I was really extremely worried, and trying to think what’s going to happen next.

KEITH KLUGMAN: There was a lot of optimism that, if we had a vaccine that could protect us, that we could minimize the size of the pandemic. And then suddenly. these variants came, almost out of left field.

DR. FOLAKE OLAYINKA: It was a race against the variants, I would say, of which I think we were far behind.

KEITH KLUGMAN: So you may be aware that, in fact, Bill Gates has written a book based on the experiences that he’s had and the advice that he’s also had from many of us at the Foundation.

In one of the opening chapters, he talks about the fact that we accept that virtually everywhere around the world, there are fire stations, there are fire brigades, there are people paid simply to be there for when the emergency occurs. We don’t have this for infectious diseases in many parts of the world.

What do you think of that analogy and do you think there’s some way, going forward, that we could be better prepared?

DR. SAMBA SOW: If you have an alarm system to tell you that smoke is coming out somewhere, you have to, for me, in places like Africa, number one, you have to make sure, do I have it. Number two, if yes, is it working? Number three, if you have extinguisher, small ones everywhere in different villages, are they working?

ANITA ZAIDI: Practicing is also important, right?

DR. SAMBA SOW: Absolutely.

ANITA ZAIDI: Just like firefighters, all of them, they practice.

DR. SAMBA SOW: Those firefighters is what I used to call during my Ebola days, the Health Army. You have to have your Health SWAT team. Before Ebola, there was nothing like that. During Ebola, we tried to set this up.

In some countries like my own, we were so lucky and fortunate to set a system like this up, and then you see how well we’ve been doing with Ebola. And now with this pandemic, nothing happened. It’s like, we forget about everything.

ANITA ZAIDI: Forgot everything.

DR. SAMBA SOW: So, we should make sure that this is not going to happen again.

DR. FOLAKE OLAYINKA: It’s not good enough for those systems to be in some places. They’ve got to be in all the places, because what this pandemic has really shown us is that we’re all at risk.


DR. FOLAKE OLAYINKA: This is an investment that will be very important in preventing the next pandemic, or ensuring that we do not have the catastrophic loss of lives, and the devastation on the economies that we have seen from the COVID pandemic.

ANITA ZAIDI: We’ve talked a lot about, in the pandemic, about being able to detect something faster. But if you can detect something faster, but you can’t do anything about it, that detection doesn’t matter, right?

You can have smoke and you can have a fire, but if you don’t have the fire extinguisher, if you don’t have the fire brigade, if you don’t have the fire station, it’s not going to work. It’s not going to make a difference. So in the same way, a health system has to be prepared to be able to respond.

KEITH KLUGMAN: I believe that Africa has largely had to weather this pandemic on its own. And unfortunately, the lifesaving vaccines that we started talking about did not materialize in time. And so today, the vast proportion of people in Africa have actually been exposed to the virus and many have died. We don’t know how many, but we have to do better.

And so, what are your thoughts about how we could do better, how we can get vaccines out quicker? How can we better arm people in poorer countries, so that they can be protected earlier?

DR. FOLAKE OLAYINKA: The level of vaccination is unacceptably low, and this, largely at the onset, was due to the lack of vaccine supply, adequate numbers, and arriving in the region. This has largely changed. The vaccine supplies are increasing. We also realize that the vaccines, and then there’s the delivery systems.

DR. SAMBA SOW: In Africa, there are places like my own country, less than 3% of the population have received even a complete vaccination, but clearly, very few, even so far, have not received a single dose of a given vaccine.

DR. FOLAKE OLAYINKA: A vaccine on a shelf, in a system where there’s ability to deliver quickly, is very different from a context where those systems do not exist.

DR. SAMBA SOW: Governments are not always ready to support, to help, and healthcare workers are already overwhelmed, and then this pandemic is coming, and it’s difficult to manage.

KEITH KLUGMAN: Are there any things that you guys would like to share with us, anything top of mind about this pandemic and how you’ve experienced it on the ground?

DR. SAMBA SOW: What I’m seeing is that, most of the time, there is a lack of great communication. There is no direct enough communication with communities.

During the pandemic, some of the investigators went to see some village leaders. They wanted to set up some studies on COVID. So the chief said to them, "We don’t want to see you here anymore because you only come here when there are big problems. During Ebola, you came, and since after that, you never came back here. So it’s like, you wait till we get close to dying, and then you come.”

It means you can only prepare a better world during peacetime. Peacetime is where really you have to try to stay in touch with people, try to build from the existing platform.

So I’m trying to say here, community first, that’s the first level.

It starts with communities. It doesn’t start in front of a computer, sitting here in Seattle, or sitting in Geneva. You have to be inside the community. You have to be where the problems are.


DR. FOLAKE OLAYINKA: I would even add to that that there are already increases in terms of other vaccine preventable diseases, particularly in Africa. Measles, being a highly infectious disease, you can imagine the buildup of unprotected –

ANITA ZAIDI: Children.

DR. FOLAKE OLAYINKA: – population. This is actually a huge risk.


ANITA ZAIDI: So you’re thinking, essential services have been affected in a very bad way?

DR. SAMBA SOW: Completely.


DR. SAMBA SOW: Completely in a bad way.

KEITH KLUGMAN: Well, this is a tragedy, and of course threatens again, the whole world. This is a global problem, and so the solutions are global, and hopefully some of the lessons learned will change the world for better.

DR. SAMBA SOW: If we don’t do well for next time, the tragedy, the consequences are going to be even worse. Inside our communities, people are starting now not to trust us anymore.

ANITA ZAIDI: If I think about, what was the biggest impact of the variants, is losing public confidence. Because then people thought like, "These guys don’t know what they’re talking about. I mean, they told us one thing but now they’re telling us something totally different."

KEITH KLUGMAN: One of the great inequities was that Africa, having discovered both the Beta and the Omicron variant, was then punished with travel bans. And can you talk a little bit about your feelings about travel bans?

DR. SAMBA SOW: I’m not a travel ban fan. I have to tell you the truth and why. No one is safe until everybody’s safe. These pathogens, they don’t need passports or visas or fingerprints to travel.

One example is Mali. When the president called me, "Samba, should we close our border? Because this country did, this one did, this one did? What do you think?” I said, "Mr. President, there is no border."

When there are crises like this, we need to unite, to work together. South Africa did a fantastic job by helping the entire world, by saving lives everywhere. But look, the consequences were very bad on them.

ANITA ZAIDI: I think the experience has showed us that border closures don’t work, unless you’re an island country.


DR. SAMBA SOW: This food is really delicious.

ANITA ZAIDI: Keith, this was just amazing. I cleaned my plate. (laughs)

KEITH KLUGMAN: Oh, I noticed, I noticed.

PARTICIPANT: And maybe I can have some leftovers to go home. (laughs)

KEITH KLUGMAN: With pleasure.

DR. SAMBA SOW: You’ll have to pass me the recipe.

DR. FOLAKE OLAYINKA: Compliments to the chef.

KEITH KLUGMAN: The recipe came from my late mother, and I’m sure she would be delighted to hear that people are still enjoying it.

DR. SAMBA SOW: C’est tres bon.

ANITA ZAIDI: Wonderful.

As we think about moving forward, what are some key lessons we should follow? What are some good things that came out of the pandemic? Are there any good things that came out? Are there any silver linings?

DR. FOLAKE OLAYINKA: With any crisis, we have to be focused on, what are the opportunities there? The investments in the vaccine technology at an unprecedented rate and speed, some diseases that we’ve been waiting for a vaccine for a long time, HIV and AIDS, can benefit from the type of systems, processes and investments that were put in place for COVID.

And I really like what Samba said, that we don’t have to wait for there to be a crisis to have the dialogue and engagement with communities. It’s about establishing relationships, and we’ve learned how to do that within this particular crisis.

DR. SAMBA SOW: Vaccine manufacturing in Africa, and we can do this step by step because you don’t want to transfer this technology so fast and let it die there, with no impact almost. It’s not only about making it, it’s also about making sure it’s being used, making sure that the quality is there, making sure the market is there functioning. We have to make sure primary healthcare system is working. We have to make sure community is heavily involved.

It’s not a matter of bringing vaccine in a country, it’s a matter of making sure those vaccines are going into muscles.

ANITA ZAIDI: And I really like the way that both of you describe this in terms of, we need to make sure that the basic health infrastructure, primary healthcare is serving the needs of people, it’s preventing measles, it’s preventing tetanus, and we can have a vision for vaccine manufacturing that will take some time to realize. But it’s an important goal to have for the long term.

DR. FOLAKE OLAYINKA: If the first set of variants took us by surprise in terms of their speed and transmissibility, the next sets certainly should not.

KEITH KLUGMAN: So, Folake, in closing, how well are we prepared now at the end of this two years of the pandemic to detect the next one? On a scale of one to 10, what do you think?

DR. FOLAKE OLAYINKA: I think we are better prepared, but we need to do more. I would say maybe we’re at a six.

KEITH KLUGMAN: Oh, well that’s hopeful.

ANITA ZAIDI: Keith, in some things, for vaccine possibilities and innovation, I think we are six or seven. I think we have made a lot of progress on how to make vaccines faster.

On the health system’s preparedness, on the detection side, on the health communication side, I would give us a two and I think that there’s just a lot more to do.

DR. SAMBA SOW: Yeah, we can reach the 10 very fast, if we do not repeat the same mistakes.

KEITH KLUGMAN: Thank both of you so much for sharing your thoughts and having this meal with us, and we really appreciate you joining us in Seattle today.

DR. SAMBA SOW: Thank you. Merci beaucoup.

DR. FOLAKE OLAYINKA: Thank you, it’s been lovely.

DR. SAMBA SOW: Thank you for sharing.

ANITA ZAIDI: Thank you.

DR. SAMBA SOW: Such a great meal.


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